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JOHN
PAUL II
Address
TO THE
PARTICIPANTS TO THE INTERNATIONAL CONGRESS "LIFE-SUSTAINING
TREATMENTS AND VEGETATIVE STATE: SCIENTIFIC ADVANCES AND ETHICAL
DILEMMAS"
Distinguished
Ladies and Gentlemen!
1.
I cordially greet all of you who took part in the International
Congress: "Life-Sustaining Treatments and Vegetative State:
Scientific Advances and Ethical Dilemmas." I wish to extend a
special greeting to Msgr. Elio Sgreccia, Vice-President of the
Pontifical Academy for Life, and to Prof. Gian Luigi Gigli, President of
the International Federation of Catholic Medical Associations and
selfless champion of the fundamental value of life, who has kindly
expressed your shared feelings.
This
important Congress, organized jointly by the Pontifical Academy for Life
and the International Federation of Catholic Medical Associations, is
dealing with a very significant issue: the clinical condition called the
"vegetative state." The complex scientific, ethical, social
and pastoral implications of such a condition require in-depth
reflections and a fruitful interdisciplinary dialogue, as evinced by the
intense and carefully structured program of your work sessions.
2.
With deep esteem and sincere hope, the Church encourages the efforts of
men of science who, sometimes at great sacrifice, daily dedicate their
task of study and research to the improvement of the diagnostic,
therapeutic, prognostic and rehabilitative possibilities confronting
those patients who rely completely on those who care for and assist
them. The person in a vegetative state, in fact, shows no evident sign
of self-awareness or of awareness of the environment, and seems unable
to interact with others or to react to specific stimuli.
Scientists
and researchers realize that one must, first of all, arrive at a correct
diagnosis, which usually requires prolonged and careful observation in
specialized centers, given also the high number of diagnostic errors
reported in the literature. Moreover, not a few of these persons, with
appropriate treatment and with specific rehabilitation programs, have
been able to emerge from vegetative state. On the contrary, many others
unfortunately remain prisoners of their condition even for long
stretches of time and without needing technological support.
In
particular, the term permanent vegetative state has been coined to
indicate the condition of those patients whose "vegetative
state" continues for over a year. Actually, there is no different
diagnosis that corresponds to such a definition, but only a conventional
prognostic judgment, relative to the fact that, statistically speaking,
the recovery of patients is ever more difficult as the condition of
vegetative state is prolonged in time.
However,
we must neither forget nor underestimate that there are well documented
cases of at least partial recovery even after many years; we can thus
state that medical science, up till now, is still unable to predict with
certainty who, among patients in this condition, will recover and who
will not.
3.
Faced with patients in similar clinical conditions, there are some who
cast doubt on the persistence of the "human quality" itself,
almost as if the adjective "vegetative" (whose use is now
solidly established), which symbolically describes a clinical state,
could or should be instead applied to the sick as such, actually
demeaning their value and personal dignity. In this sense, it must be
noted that this term, even when confined to the clinical context, is
certainly not the most felicitous when applied to human beings.
In
opposition to such trends of thought, I feel the duty to reaffirm
strongly that the intrinsic value and personal dignity of every human
being do not change, no matter what the concrete circumstances of his or
her life. A man, even if seriously ill or disabled in the exercise of
his highest functions, is and always will be a man, and he will never
become
a "vegetable" or an "animal."
Even
our brothers and sisters who find themselves in the clinical condition
of a "vegetative state" retain their human dignity in all its
fullness. The loving gaze of God the Father continues to fall upon them,
acknowledging them as his sons and daughters, especially in need of
help.
4.
Medical doctors and health care personnel, society and the Church have
toward these persons moral duties from which they cannot exempt
themselves without lessening the demands both of professional ethics and
human and Christian solidarity.
The
sick person in a vegetative state, awaiting recovery or a natural end,
still has the right to basic health care (nutrition, hydration,
cleanliness, warmth, etc), and to the prevention of complications
related to his confinement to bed. He also has the right to appropriate
rehabilitative care and to be monitored for clinical signs of eventual
recovery.
I
should like particularly, to underline how the administration of water
and food, even when provided by artificial means, always represents a
natural means of preserving life, not a medical act. Its use,
furthermore, should be considered, in principle, ordinary and
proportionate, and as such morally obligatory, insofar as and until it
is seen to have attained its proper finality, which in the present case
consists in providing nourishment to the patient and alleviation of his
suffering.
The
obligation to provide the "normal care due to the sick in such
cases" (Congregation for the Doctrine of the Faith, Iura et bona,
p. IV) includes, in fact, the use of nutrition and hydration (cf.
Pontifical Council "Cor Unum", Dans le cadre, 2.4.4;
Pontifical Council for Pastoral Assistance to Health Care Workers,
Charter of Health Care Workers, no. 120). The evaluation of
probabilities, founded on waning hopes for recovery when the vegetative
state is prolonged beyond a year, cannot ethically justify the cessation
or interruption of minimal care for the patient including nutrition and
hydration. Death by starvation or thirst is, in fact, the only possible
outcome as a result of their withdrawal. In this sense it ends up
becoming, if done knowingly and willingly, true and proper euthanasia by
omission.
In
this regard, I recall what I wrote in the Encyclical Evangelium vitae,
making it clear that "by Euthanasia in the true and proper sense
must be understood an action or omission which by its very nature and
intention brings about death, with the purpose of eliminating all
pain"; such an act is always "a serious violation of the law
of God, since it is the deliberate and morally unacceptable killing of a
human person" (no. 65).
Besides,
the moral principle is well known, according to which even the simple
doubt of being in the presence of a living person already imposes the
obligation of full respect and of abstaining from any act that aims at
anticipating the person's death.
5.
Considerations about the "quality of life," often actually
dictated by psychological, social and economic pressures, cannot take
precedence over general principles.
First
of all, no evaluation of costs can outweigh the value of the fundamental
good which we are trying to protect, that of human life. Moreover, to
admit that decisions regarding man's life can be based on the external
acknowledgment of its quality, is the same as acknowledging that
increasing and decreasing levels of quality of life, and therefore of
human dignity, can be attributed, from an external perspective, to any
subject, thus introducing into social relations a discriminatory and
eugenic principle.
Moreover,
it is not possible to rule out a priori that the withdrawal of nutrition
and hydration, as reported by authoritative studies, is the source of
considerable suffering for the sick person, even if we can see only the
reactions at the level of the autonomic nervous system or of gestures.
Modern clinical neurophysiology and neuro-imaging techniques, in fact,
seem to point to the lasting quality in these patients of elementary
forms of communication and analysis of stimuli.
6.
However, it is not enough to reaffirm the general principle according to
which the value of a man's life cannot be made subordinate to any
judgment of its quality expressed by other men; it is necessary to
promote the taking of positive actions as a stand against pressures to
withdraw hydration and nutrition as a way to put an end to the lives of
these patients.
It
is necessary, above all, to support those families who have had one of
their loved ones struck down by this terrible clinical condition. They
cannot be left alone with their heavy human, psychological and financial
burden. Although the care for these patients is not, in general,
particularly costly, society must allot sufficient resources for the
care of this sort of frailty, by way of bringing about appropriate,
concrete initiatives such as, for example, the creation of a network of
awakening centers, with specialized treatment and rehabilitation
programs; financial support and home assistance for families, when
patients are moved back home at the end of intensive rehabilitation
programs; the establishment of facilities which can accommodate those
cases in which there is no family able to deal with the problem or to
provide "breaks" for those families who are at risk of
psychological and moral burn-out.
.
Proper
care for these patients and their families should, moreover, include the
presence and the witness of a medical doctor and an entire team, who are
asked to help the family understand that they are there as allies who
are in this struggle with them. The participation of volunteers
represents a basic support to enable the family to break out of its
isolation and to help it to realize that it is a precious and not a
forsaken part of the social fabric.
In
these situations, then, spiritual counseling and pastoral aid are
particularly important as they help recover the deepest meaning of an
apparently desperate condition.
7.
Distinguished Ladies and Gentlemen, in conclusion I exhort you, as men
and women of science, responsible for the dignity of the medical
profession, to guard jealously the principle according to which the true
task of medicine is "to cure if possible, always to care."
As
a pledge and support of this, your authentic humanitarian mission to
give comfort and support to your suffering brothers and sisters, I
remind you of the words of Jesus: "Amen, I say to you, whatever you
did for one of these least brothers of mine, you did for me."(Mt
25, 40).
In
this light, I invoke upon you the assistance of Him, whom a meaningful
saying of the Church Fathers describes as Christus medicus and, in
entrusting your work to the protection of Mary, Consoler of the sick and
Comforter of the dying, I lovingly bestow on all of you a special
Apostolic Blessing.
(Unofficial
English version. Original Italian version published in "L'Osservatore
Romano", Sabato-Domenica, 20-21 Marzo, p. 5)
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